tv [untitled] March 14, 2012 9:00pm-9:30pm EDT
so that's where the work goes on. and when i look in this room, i see that we're ready to roll up our sleeves and get the job done. jim and i asked you here today to kick off a new set of parity hearings as he talked about, and we're going to wrap them up a year from now at the john f. kennedy library to mark the 50th anniversary of president kennedy's signing of the community mental health services act. so all these hearings that you're going to organize will build to that momentum so that we can look back at the last 50 years, find out what we did wrong and make sure we correct it before we implement final regs for mental health care and before we make these mistakes again and perpetuate more misery on americans who are struggling for recovery. we are wanting to say, we deny insurance companies rights to deny us our rights. and we're going to take that message across the country in
key cities. but ultimately, as jim said, this is up to you. this is up to the advocate. and frederick douglas, the great appear li abolitionist said power concedes nothing without demand. it never has and it never will. until the mental health community is willing to stand up, be counted and demand equal treatment and care, we're never going to get to where we ultimately all want to go. so like the labor movement, like the civil rights movement, we're going to create the demand for sherry glade and pam hyde to do the work they're already doing. it's not going to happen without all of you. my uncle bobby said every time a person stands up or improves the lot of others, they send through a tiny ripple of hope. and coming through the centers
of energy and daring, they bring ripples up and down the walls. we can do this together. i learned in recovery that half measures availed me nothing. we need to be in this all the way, and with the committed audience i see out here today, we're going to be successful in getting the job done. thank you very much. [ applause ] >> thank you both for speaking here today, and now i know the part that everybody is waiting for is our questions and answers. if i can get both of you to join me up here, the questions aren't directed to either one of you, so you can decide who wants to take the questions. the first one is the original bill was passed in the 1990s but the insurance companies used loopholes to avoid parity for mental health coverage. are there safeguards in place to prevent that in this one? >> i think it would be
appropriate to hear from our wonderful director of the substance abuse mental health administration, pam hyde, who has been working on just that, and i know from sherri glade as well, but let me have our champion for this, pam hyde, say a few words about how important it is that we get the message across on mental health parity and how key all of you are in helping us so that we solve these questions that are before us today. pam, would you be good enough to come up and talk to us a little bit? let's give a great round of applause to pam hyde. [ applause ] >> thank you, congressman, both of you, for your compassion and devotion to this issue. i'm not going to do a whole speech here, although i could do that if we had the time. i just want to say that samsa is
very clear that mapea, as we about here, is just the start. mapea calls for equal treatment. it doesn't call for the best and most appropriate treatment. i think what we're talking about here is more than that. what we understand is no law and no regulation is going to be as good as it can be unless we get the word out that it's there and that it can be used. so samsa is committed to doing that. we have developed a communications plan. we have webinars that we have started and working with some of the key target areas we want to get the word out to. we're going to build on or jump on the bandwagon of the patriots' tour and see if we can help facilitate getting information out to -- mostly to consumers who may have behavioral health issues and who may be needing treatment for those issues, and for providersd
in providing that kind of care but don't know how their clients are going to get that paid for. so we want to focus some very targeted efforts. we weren't given any money to do this. we've tried to identify very few resources to do it and we're going to try to lead an effort to do that as best we can. is a that's one of the roles that we're playing. and we want to use this issue to understand that mapea was expanded into the health care law and the national health care act, in fact, that's more important than mapea standing alone, because there are ways that we're using all of health care reform and trying to make sure that mental health and substance abuse treatment, addiction, recovery is in each one of the efforts that is going on in implementing the
affordable care act. so whether it's the quality issues that samsa is working on quality framework about, or whether it's the prevention efforts in which we've tried to make sure that substance abuse and mental health issues are involved, or whether it is essential health benefits, which i think sherri is going to talk about really briefly, in any one of those cases, we're trying to make sure that mental health and substance abuse is included in that. because parity is about more than just being equal, it is about being appropriate and necessary to move the nation's behavioral health being very essential to health. given the time and the question that i was asked, i'm going to stop there and just let you know that there's lots more work than samhsa is doing about these issues, and we would be very happy to be partners in these field areas and other issues as we move along. thank you. [ applause ] >> what states are doing the best job in implementing mental
health parities? >> rhode island. well, we aim to be number one, because tragically, according to pam's study, rhode island is number one in the incident rate of mental illness and addiction. but perhaps that's also because there is a lot less stigma in t of great providers in rhode island, so people don't have a tough time admitting and seeking help, which is one of the reasons why weig look at it one way or you could look at it another way. but either way, we intend to be part of the solution in coming up with a model that hopefully other states like minnesota can follow. the honest answer to that question is that it's very difficult to quantify it, seriously. and we have some very powerful special interests, as paul
wellstone said early on, he was quick to recognize our fighting parity, and that's unfortunate. we're trying to do a better job with education. i think it's important to point out that right before we passed the bill, we had eight major insurance companies, major health plans nationally supporting the bill. came up and testified. the first one to come on board was way back in the '90s, kaiser permanente. and i don't want to get into which insurance company is helping and which is not, but we need them to understand that this is not only the right thing to do, to enact parity, but it's the cost-effective thing to do. for every dollar we spend in treatment from people who are suffering from mental disorders or addiction disorders, we save $12. we save $12 in health care costs and not having to build new jails and new prisons service costs.
as my good friend dr. ron smith always points out, who is chief psychiatry for the navy, is not having to buy ritalin for the children, for families that are dysfunctional and so forth. so we need to do a better job of educating as well as enforcing the new law. >> have the fears of the insurance companies been lessened or increased since the bill passed? >> well, at the end of the day, we need to work with the insurance community, because if at the end of the day, they're structuring the benefit plan, we need to be at the table when they structure that benefit plan. so i want to invite the insurance companies to join us at these parity hearings around the country and to develop that working relationship that's already getting started. because at the end of the day, we all need each other, and we need to find a way out of this together. >> i'd just like to quickly second that. we need to work in a
collaborative way, and you can't continue to be us versus them or we versus they. it needs to be a collaborative effort of cooperation and we need to find that common ground, which is sorely missing, i've noticed, in this city. >> how would you encourage advocates to influence the states regarding mental health? >> well, you know, if you go on the samsa web site and you talk to folks, it's important that you get to know your local insurance commissioner in your state. in my state, chris kohler told me that he hears from providers during denial coverage from insurance companies, but he doesn't hear from advocates enough. so what we're saying to all of you is, as the advocate, we can't leave this up to the provider to fight for us. we can't expect the administration to do this by themselves. it's got to be up to us to stand
up for our own and make sure that the right thing is done. and i want to acknowledge someone who has been helping to do that, assistant secretary of health, and who has been working to get mental health incorporated, as pam said, into the affordable care act, and that's none other than sherri glade. let's hear a great round of applause for sherri glade. [ applause ] >> i just want to speak very briefly to that point. i think one of the really important things that you could do at the state level right now is influence states in their selection of essential health benefits. the way we've laid out the law, states have a choice of benchmarks between their small group plans and large employer plans and so on. one of the things that that makes possible is for states to include, if they choose, their existing mental health mandates in the essential health in the pact they choose. so for some states who have a strong advocacy influence and
have extensive mental health/substance abuse man dates in place, with appropriate advocacy, i think there is a possibility for those states to choose a ben fits as the essent health benefits plan that will cover basically 70 million newly insured people. >> how do you encourage employers to offer mental health benefits? >> we have shown many, many employers, many, many insurance companies empirical data. we show a cost savings both on f treating people. the average untreated alcoholic or addict's health costs, for example, are 100% higher than others who are in recovery. 100% higher.
just think of that. the average person out there who is addicted and is drugging or drinking still, their health care costs 100% higher than the treated alcoholic or a person suffering from a mental disorder. the cost the wall street journal pointed out not long ago, $30 billion sucked out of for depression in the workplace. i could go on and on with the litany of costs. what we do is show them, whether it's the new england journal of medicine study, the minnesota study, the california study, just -- i could go on and on. there have been many, many studies corroborating what i'm saying, that this, in the end, will save the insurance companies money. and those eight companies who support parity learned that first and learned it well and understand that. >> do you think the anonymous and alcoholics anonymous
contributes to the stigma against addicts? >> i didn't really have a choice whether i was going to be anonymous or not, so i often get a lot of grief from my but at the same time i'm a u.s. citizen and one of the things phil w. did was he testified in congress. a lot of people in recovery don't know that. because it was about saving our fellows, and one of the ways we save our fellows is to advocate for parity, to advocate for enough treatment, to advocate for reimbursement. that's the way i can do one giant 12-step call is to advocate for a different system that will help millions. but if we're not politically engaged, then we're leaving this to someone else. and if we could ever tap those 20-some million people in long-term recovery in this country right now to say that they're willing to put their hand up and be a face and voice
of recovery, you change this overnight. because that would be a big difference. [ applause ] >> have you met or talked with people who have been helped by your legislation? >> yes, i have, in minnesota with several dozen people who have been benefitted. families who have come to break bread with me and tell me of their happy experiences. but, unfortunately, there's still more people every day who call me, literally every day, who call me who are still suffering and who can't access treatment. but there are some very, very rewarding and enriching personal experiences that have been related to me directly. >> does the u.s. government invest enough in mental health
research? >> that was a softball. obviously when we don't treat this as a real illness, we don't respond to it with the same urgency that we would have you had cancer or aids or some other disease. so what we need to do first is end stigma because stigma is what's keeping us from reaching our full potential in terms of advocacy. when we get that advocacy, then we need to focus on how we're spending our current resources so we're not dividing up our effort and repeating it over and over again because we failed to share the science across these brain-related disorders, and that, as i said earlier, is the project of one mind for research. but at the end of the day, prevention -- prevention -- prevention is the best answer of all, and you don't need to go back to the lab to be able to tell a parent that it's not okay
for them to experience with drugs and alcohol. that's not just an experimental phase. the longer they don't use or abuse drugs and alcohol, the better chance they have of living a life free from addiction and dependency. we need to get that message across. [ applause ] >> how do you see the mental health parity act helping our soldiers receive treatment for ptsd? >> first of all, stigma, stigma, stigma. again, one of the biggest challenges is there's stigma everywhere. of course, if you're a young soldier who is used to doing whatever it takes to get the job done, then you don't want to be told that you have a problem that's stigmatized, where it's treated as a moral issue and not a medical issue. but let me tell you an interesting anecdote. i rededicated the kennedy
warfare center in fort bragg a few months ago, and the first chief of staff, a green beret, told me, you know, we have the best medical staff in the military. and i said, you don't need to tell me that, general. why do they need mental health? they jump out of planes, they swim under water for two miles without breathing, they come out of the beach, they speak five languages, they take out osama bin laden and they're home by dinnertime to read to their kids. what do they need mental health for? he said, congressman, you mistake me. we don't look at mental health as a safety net. and this is the real good part. he said, we look at it as a forced multiplier. a forced multiplier. so the military has figured out that if you help address someone's preoccupations and issues, you help make them a better fighter. how about all americans who could always be made better through self-improvement? how about looking at mental health, instead of taking,
quote, weak people, making strong people even stronger, and that's ultimately a message we need. [ applause ] >> just very briefly, whenever i think of that question em bowled nd that question, i think of john in minnesota who came back, i think, from the second or third tour of duty in iraq and couldn't access treatment, whether it be the va or insurance -- i don't think he had insurance -- and he was found hanging by an electric cord in his basement. and he's one of 18 a day, according to "60 minutes." new veterans coming back from iraq and afghanistan who are taking their own lives, and when the statistics that have been
shared by the military themselves -- itself -- the military shows that one out of four veterans who have served more than two or more tours is suffering from ptsd and one in five from chemical addiction. so we've got to deal with treating these people. we have an obligation, the highest obligation. not just a moral obligation from all the other perspectives. it only makes sense to do the right thing and that is to address their treatment needs. >> do you think there should be a limit on soldiers' tours of duty? >> they're a lot more courageous than me when they go overseas and put their life on the line for all of us. all i know is that we owe them a
lot more than what they're getting when they come home. they may come home in body but not in mind, and we can't allow that. we need to be there for them in the smallest way just like they were there for us by keeping another terrorist's attacks from coming on our shores. we can't do enough for our nation's veterans. [ applause ] >> some patients with mental illnesses, including eating disorders, are having to testify to medical directors of insurance companies to prove they need treatment. what advice do you have for them? >> well, as is evidenced by today's gathering, none of this is going to happen unless we continue to fight. and that means we need to be vigilant. seen, let's say, in two years from now ultimately done as far as the affordable care act, we're going to have to be vigilant consta
constant constantly. what we need to do is keep people feeling comfortable as far as their right as consumers now, because they're going to have to keep standing up. that's just the way life is. and we need everybody to not only be involved in the beginning but to stay involved over time. >> no person should be forced to be examined by a medical director to prove that he or she has an illness if an eating disorder has been diagnosed by a physician, and we are hopeful that the final rule will encompass eating disorders, which is tragically the number one killer of young women in america today. >> one of the barriers to successfully resolving the many parity complaints is the lack of final rule that you mentioned earlier. what can we do to help in the efforts to secure final regulations?
>> that's exactly what the parity tour is all about, to get people to tat the grassroots le citizens, people who care, whose families are affected, people who have a heart for those suffering from mental illness and addiction to talk -- make sure your member of congress, make sure your united states senators, make sure they support the final rule and make sure they make their thoughts known. it's not enough to just say, yeah, we'll support you, pat you on the head and send you on your way. we've got to make sure that their influence is felt at the administrative level, the people who make the decisions, and this final rule really is in the hands of three cabinet secretaries, secretary geithner, secretary hilda celeste, and
secretary sebelius. >> the use of electronic medical records is increasingly connecting health care providers. do you think stigma is deterring mental health care providers from participating? >> well, interestingly, we're talking about parity today. do you realize that we don't treat health care records for mental health clinics the same way we would health care records for community health care clinics or hospitals. talk about parity. parity is
way. >> can you weigh in on the drug legalization controversy, and do you think legalization would increase drug abuse in america? >> i take the tough ones, he gets the softballs. big brother, little brother. i have never talked, not one, in my 20 years of public service, state level as a state senator or here in congress, neverhed f chemical health professional or a teacher or a parent, for that matter, who favors legalization. i think the studies show, which are the so-called entry-level drugs, marijuana is the number one entry-level drugs. people graduate to hard drugs
from initial use of marijuana and addiction to marijuana. there are some people still that don't believe that marijuana is addictive. well, believe me, as one who went through treatment 30 years ago and three out of the eight members in my small group were addicted to nothing but marijuana, and in the 30 years of being a recovering person in the recovering community, i have met literally hundreds, if not thousands, of people whose addiction is marijuana. so no, i don't support legalization. i understand the argument, but i don't agree with them. and more important than me, who is no expert as far as the technical aspects are concerned of this issue, i think the input of people who deal with young people every day and that is teachers, chemical health professionals and certainly their parents.
[ applause ] >> we already have a legalized drug, and that's alcohol. i wish we had the same attitudes about alcohol use as we have about smoking, because that's been legal, too, but we look at smoking a whole different way after we changed our attitudes about everybody smoking. so we had a permissive environment that says it's all right to drink hard and especially when you're young. well, we know this has lifelong implications in terms of people's propensity to become lifelong problem drinkers and alcoholics if they start young. so we need to have some moral persuasion here, okay? this is also about not only treating a medical issue, but we do have responsibility -- if you know you have a problem, there is no excuse for you not to try to do something about it.
so it's not enough for people to hide behind the medical diagnosis that you're an addict, you're an alcoholic, you're depressed and then not do anything about it, because your disease is affecting your family and your friends. and if you care enough about them, then you have an obligation to get treatment about yourself. so the first question anybody ought to ask is, do i have a problem? and if i decide that i do, what am i going to do to get help? [ applause ] >> why has the implementation of the act been so slow? >> that's the question i've asked of a lot of people, and i have gotten -- i've asked probably over 100 people and gotten 100 different answers. i don't know. we've been very, very frustrated. i've been involved in a number of pieces of legislation, many times as the token republican in
a bipartisan bill, which i was always proud to join in on, for example, the prime bill in 1994, the clinton prime bill. that has good prevention and good treatment initiatives and emphasized the demand side of the equation. until and unless we put the emphasis on the demand side of the equation, we're never going to deal with the supply side. i'll never forget traveling with president clinton to mexico in my first term and -- or second term, i guess, his first term. but anyway, we met with then president zadao. i'll never forget president clinton at a small dinner there. there were about five of us from congress on the delegation, about five ministers from mexico and the two heads of state. and i'll never forget president clinton asking president zadao, when are you going to deal with the flow of drugs coming to your coy